LCD Reference Article Billing and Coding Article

Billing and Coding: Somatosensory Testing

A57540

Expand All | Collapse All

Contractor Information

Contractor Name	Contract Type	Contract Number	Jurisdiction	States
First Coast Service Options, Inc.	A and B MAC	09102 - MAC B	J - N	Florida
First Coast Service Options, Inc.	A and B MAC	09202 - MAC B	J - N	Puerto Rico
First Coast Service Options, Inc.	A and B MAC	09302 - MAC B	J - N	Virgin Islands

Article Information

General Information

Article ID
A57540

Article Title
Billing and Coding: Somatosensory Testing

Article Type
Billing and Coding

Original Effective Date
10/03/2018

Revision Effective Date
03/08/2024

Revision Ending Date
N/A

Retirement Date
N/A

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Copyright © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Social Security Act (Title XVIII) Standard References:

Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33958 Somatosensory Testing. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Quantitative Sensory Testing (QST) performed with portable hand-held devices (e.g., current, vibration, thermal perception, or tactile) does not represent somatosensory evoked potential testing and should not be billed using the somatosensory codes (95925, 95926, 95927, or 95938). QST testing is considered part of the evaluation and management service, and therefore, should not be billed separately.

When billing for intraoperative somatosensory testing during spinal surgeries, procedure code 95940 (Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance ,each 15 minutes [List separately in addition to code for primary procedure]) or G0453 (Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient (attention directed exclusively to one patient), each 15 minutes list in addition to primary procedure]) should be billed in conjunction with the study performed (95925, 95926, or 95927, or 95938). It would not be acceptable for the performing neurosurgeon to bill for the intraoperative monitoring, as another provider performs this while the surgery is in progress. Intraoperative monitoring performed by a technician is not separately reimbursable. It is not expected that intraoperative testing would be necessary for routine lumbar or cervical root decompression.

Multiple services and/or the bilateral procedure modifiers do not apply, as the code descriptors for these services include “stimulation of any/all peripheral nerves or skin sites".

Documentation Requirements

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
There should be evidence in the medical record that the test results were noted and influenced or contributed to the patient’s course of treatment.
Documentation that the service was performed must be included in the patient’s medical record. This documentation should include a hard copy computer generated recording of the test results along with the physician’s interpretation. The physician’s SEP report should note which nerves were tested, latencies at various testing points, and an evaluation of whether the resulting values are normal or abnormal.
If the provider of somatosensory testing is other than the ordering/referring physician/non-physician practitioner, the provider of the service must maintain a copy of the test results and interpretation, along with copies of the ordering/referring physician/non-physician practitioner’s order for the studies.

Response To Comments

Number	Comment	Response
1

Coding Information

Bill Type Codes

Code	Description
999x	Not Applicable

Revenue Codes

Code	Description
99999	Not Applicable

CPT/HCPCS Codes

Expand All | Collapse All

Group 1

(4 Codes)

Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes

Code	Description
95925	Somatosensory testing
95926	Somatosensory testing
95927	Somatosensory testing
95938	Somatosensory testing

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Expand All | Collapse All

Group 1

(277 Codes)

Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 95925, 95926, 95927, and 95938.

Group 1 Codes

Code	Description
A52.15	Late syphilitic neuropathy
C72.0	Malignant neoplasm of spinal cord
C72.1	Malignant neoplasm of cauda equina
C79.31	Secondary malignant neoplasm of brain
D32.0	Benign neoplasm of cerebral meninges
D32.1	Benign neoplasm of spinal meninges
D33.4	Benign neoplasm of spinal cord
D43.0	Neoplasm of uncertain behavior of brain, supratentorial
D43.1	Neoplasm of uncertain behavior of brain, infratentorial
D43.2	Neoplasm of uncertain behavior of brain, unspecified
D43.4	Neoplasm of uncertain behavior of spinal cord
E03.5	Myxedema coma
E08.40	Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified
E08.42	Diabetes mellitus due to underlying condition with diabetic polyneuropathy
E09.40	Drug or chemical induced diabetes mellitus with neurological complications with diabetic neuropathy, unspecified
E09.42	Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy
E10.40	Type 1 diabetes mellitus with diabetic neuropathy, unspecified
E10.41	Type 1 diabetes mellitus with diabetic mononeuropathy
E10.42	Type 1 diabetes mellitus with diabetic polyneuropathy
E10.43	Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy
E10.44	Type 1 diabetes mellitus with diabetic amyotrophy
E10.49	Type 1 diabetes mellitus with other diabetic neurological complication
E10.610	Type 1 diabetes mellitus with diabetic neuropathic arthropathy
E11.42	Type 2 diabetes mellitus with diabetic polyneuropathy
E13.40	Other specified diabetes mellitus with diabetic neuropathy, unspecified
E13.42	Other specified diabetes mellitus with diabetic polyneuropathy
G11.0	Congenital nonprogressive ataxia
G11.11	Friedreich ataxia
G11.19	Other early-onset cerebellar ataxia
G11.2	Late-onset cerebellar ataxia
G11.4	Hereditary spastic paraplegia
G13.0	Paraneoplastic neuromyopathy and neuropathy
G13.1	Other systemic atrophy primarily affecting central nervous system in neoplastic disease
G25.3	Myoclonus
G35	Multiple sclerosis
G60.0	Hereditary motor and sensory neuropathy
G60.1	Refsum's disease
G60.2	Neuropathy in association with hereditary ataxia
G60.3	Idiopathic progressive neuropathy
G60.8	Other hereditary and idiopathic neuropathies
G60.9	Hereditary and idiopathic neuropathy, unspecified
G61.0	Guillain-Barre syndrome
G61.1	Serum neuropathy
G61.81	Chronic inflammatory demyelinating polyneuritis
G61.82	Multifocal motor neuropathy
G61.89	Other inflammatory polyneuropathies
G61.9	Inflammatory polyneuropathy, unspecified
G62.0	Drug-induced polyneuropathy
G62.1	Alcoholic polyneuropathy
G62.2	Polyneuropathy due to other toxic agents
G62.81	Critical illness polyneuropathy
G62.82	Radiation-induced polyneuropathy
G62.89	Other specified polyneuropathies
G62.9	Polyneuropathy, unspecified
G63	Polyneuropathy in diseases classified elsewhere
G64	Other disorders of peripheral nervous system
G65.0	Sequelae of Guillain-Barre syndrome
G65.1	Sequelae of other inflammatory polyneuropathy
G65.2	Sequelae of toxic polyneuropathy
G95.0	Syringomyelia and syringobulbia
G95.20	Unspecified cord compression
G95.29	Other cord compression
G95.9	Disease of spinal cord, unspecified
I65.01	Occlusion and stenosis of right vertebral artery
I65.02	Occlusion and stenosis of left vertebral artery
I65.03	Occlusion and stenosis of bilateral vertebral arteries
I65.21	Occlusion and stenosis of right carotid artery
I65.22	Occlusion and stenosis of left carotid artery
I65.23	Occlusion and stenosis of bilateral carotid arteries
I67.1	Cerebral aneurysm, nonruptured
M05.50	Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified site
M05.511	Rheumatoid polyneuropathy with rheumatoid arthritis of right shoulder
M05.512	Rheumatoid polyneuropathy with rheumatoid arthritis of left shoulder
M05.519	Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified shoulder
M05.521	Rheumatoid polyneuropathy with rheumatoid arthritis of right elbow
M05.522	Rheumatoid polyneuropathy with rheumatoid arthritis of left elbow
M05.529	Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified elbow
M05.531	Rheumatoid polyneuropathy with rheumatoid arthritis of right wrist
M05.532	Rheumatoid polyneuropathy with rheumatoid arthritis of left wrist
M05.539	Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified wrist
M05.541	Rheumatoid polyneuropathy with rheumatoid arthritis of right hand
M05.542	Rheumatoid polyneuropathy with rheumatoid arthritis of left hand
M05.549	Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified hand
M05.551	Rheumatoid polyneuropathy with rheumatoid arthritis of right hip
M05.552	Rheumatoid polyneuropathy with rheumatoid arthritis of left hip
M05.559	Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified hip
M05.561	Rheumatoid polyneuropathy with rheumatoid arthritis of right knee
M05.562	Rheumatoid polyneuropathy with rheumatoid arthritis of left knee
M05.569	Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified knee
M05.571	Rheumatoid polyneuropathy with rheumatoid arthritis of right ankle and foot
M05.572	Rheumatoid polyneuropathy with rheumatoid arthritis of left ankle and foot
M05.579	Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified ankle and foot
M05.59	Rheumatoid polyneuropathy with rheumatoid arthritis of multiple sites
M34.83	Systemic sclerosis with polyneuropathy
M47.011	Anterior spinal artery compression syndromes, occipito-atlanto-axial region
M47.012	Anterior spinal artery compression syndromes, cervical region
M47.013	Anterior spinal artery compression syndromes, cervicothoracic region
M47.014	Anterior spinal artery compression syndromes, thoracic region
M47.015	Anterior spinal artery compression syndromes, thoracolumbar region
M47.016	Anterior spinal artery compression syndromes, lumbar region
M47.019	Anterior spinal artery compression syndromes, site unspecified
M47.021	Vertebral artery compression syndromes, occipito-atlanto-axial region
M47.022	Vertebral artery compression syndromes, cervical region
M47.029	Vertebral artery compression syndromes, site unspecified
M47.11	Other spondylosis with myelopathy, occipito-atlanto-axial region
M47.12	Other spondylosis with myelopathy, cervical region
M47.13	Other spondylosis with myelopathy, cervicothoracic region
M47.15	Other spondylosis with myelopathy, thoracolumbar region
M47.22	Other spondylosis with radiculopathy, cervical region
M47.812	Spondylosis without myelopathy or radiculopathy, cervical region
M47.816	Spondylosis without myelopathy or radiculopathy, lumbar region
M48.01	Spinal stenosis, occipito-atlanto-axial region
M48.02	Spinal stenosis, cervical region
M48.03	Spinal stenosis, cervicothoracic region
M48.061	Spinal stenosis, lumbar region without neurogenic claudication
M48.062	Spinal stenosis, lumbar region with neurogenic claudication
M48.07	Spinal stenosis, lumbosacral region
M99.20	Subluxation stenosis of neural canal of head region
M99.21	Subluxation stenosis of neural canal of cervical region
M99.23	Subluxation stenosis of neural canal of lumbar region
M99.30	Osseous stenosis of neural canal of head region
M99.31	Osseous stenosis of neural canal of cervical region
M99.33	Osseous stenosis of neural canal of lumbar region
M99.40	Connective tissue stenosis of neural canal of head region
M99.41	Connective tissue stenosis of neural canal of cervical region
M99.43	Connective tissue stenosis of neural canal of lumbar region
M99.50	Intervertebral disc stenosis of neural canal of head region
M99.51	Intervertebral disc stenosis of neural canal of cervical region
M99.53	Intervertebral disc stenosis of neural canal of lumbar region
M99.60	Osseous and subluxation stenosis of intervertebral foramina of head region
M99.61	Osseous and subluxation stenosis of intervertebral foramina of cervical region
M99.63	Osseous and subluxation stenosis of intervertebral foramina of lumbar region
M99.70	Connective tissue and disc stenosis of intervertebral foramina of head region
M99.71	Connective tissue and disc stenosis of intervertebral foramina of cervical region
M99.73	Connective tissue and disc stenosis of intervertebral foramina of lumbar region
R40.20	Unspecified coma
R40.2110	Coma scale, eyes open, never, unspecified time
R40.2111	Coma scale, eyes open, never, in the field [EMT or ambulance]
R40.2112	Coma scale, eyes open, never, at arrival to emergency department
R40.2113	Coma scale, eyes open, never, at hospital admission
R40.2114	Coma scale, eyes open, never, 24 hours or more after hospital admission
R40.2120	Coma scale, eyes open, to pain, unspecified time
R40.2121	Coma scale, eyes open, to pain, in the field [EMT or ambulance]
R40.2122	Coma scale, eyes open, to pain, at arrival to emergency department
R40.2123	Coma scale, eyes open, to pain, at hospital admission
R40.2124	Coma scale, eyes open, to pain, 24 hours or more after hospital admission
R40.2210	Coma scale, best verbal response, none, unspecified time
R40.2211	Coma scale, best verbal response, none, in the field [EMT or ambulance]
R40.2212	Coma scale, best verbal response, none, at arrival to emergency department
R40.2213	Coma scale, best verbal response, none, at hospital admission
R40.2214	Coma scale, best verbal response, none, 24 hours or more after hospital admission
R40.2220	Coma scale, best verbal response, incomprehensible words, unspecified time
R40.2221	Coma scale, best verbal response, incomprehensible words, in the field [EMT or ambulance]
R40.2222	Coma scale, best verbal response, incomprehensible words, at arrival to emergency department
R40.2223	Coma scale, best verbal response, incomprehensible words, at hospital admission
R40.2224	Coma scale, best verbal response, incomprehensible words, 24 hours or more after hospital admission
R40.2310	Coma scale, best motor response, none, unspecified time
R40.2311	Coma scale, best motor response, none, in the field [EMT or ambulance]
R40.2312	Coma scale, best motor response, none, at arrival to emergency department
R40.2313	Coma scale, best motor response, none, at hospital admission
R40.2314	Coma scale, best motor response, none, 24 hours or more after hospital admission
R40.2320	Coma scale, best motor response, extension, unspecified time
R40.2321	Coma scale, best motor response, extension, in the field [EMT or ambulance]
R40.2322	Coma scale, best motor response, extension, at arrival to emergency department
R40.2323	Coma scale, best motor response, extension, at hospital admission
R40.2324	Coma scale, best motor response, extension, 24 hours or more after hospital admission
R40.2340	Coma scale, best motor response, flexion withdrawal, unspecified time
R40.2341	Coma scale, best motor response, flexion withdrawal, in the field [EMT or ambulance]
R40.2342	Coma scale, best motor response, flexion withdrawal, at arrival to emergency department
R40.2343	Coma scale, best motor response, flexion withdrawal, at hospital admission
R40.2344	Coma scale, best motor response, flexion withdrawal, 24 hours or more after hospital admission
R40.2A	Nontraumatic coma due to underlying condition
S12.000A	Unspecified displaced fracture of first cervical vertebra, initial encounter for closed fracture
S12.000B	Unspecified displaced fracture of first cervical vertebra, initial encounter for open fracture
S12.000D	Unspecified displaced fracture of first cervical vertebra, subsequent encounter for fracture with routine healing
S12.000G	Unspecified displaced fracture of first cervical vertebra, subsequent encounter for fracture with delayed healing
S12.000K	Unspecified displaced fracture of first cervical vertebra, subsequent encounter for fracture with nonunion
S12.000S	Unspecified displaced fracture of first cervical vertebra, sequela
S12.001A	Unspecified nondisplaced fracture of first cervical vertebra, initial encounter for closed fracture
S12.001B	Unspecified nondisplaced fracture of first cervical vertebra, initial encounter for open fracture
S12.001D	Unspecified nondisplaced fracture of first cervical vertebra, subsequent encounter for fracture with routine healing
S12.001G	Unspecified nondisplaced fracture of first cervical vertebra, subsequent encounter for fracture with delayed healing
S12.001K	Unspecified nondisplaced fracture of first cervical vertebra, subsequent encounter for fracture with nonunion
S12.001S	Unspecified nondisplaced fracture of first cervical vertebra, sequela
S14.101A	Unspecified injury at C1 level of cervical spinal cord, initial encounter
S14.101D	Unspecified injury at C1 level of cervical spinal cord, subsequent encounter
S14.101S	Unspecified injury at C1 level of cervical spinal cord, sequela
S14.102A	Unspecified injury at C2 level of cervical spinal cord, initial encounter
S14.102D	Unspecified injury at C2 level of cervical spinal cord, subsequent encounter
S14.102S	Unspecified injury at C2 level of cervical spinal cord, sequela
S14.103A	Unspecified injury at C3 level of cervical spinal cord, initial encounter
S14.103D	Unspecified injury at C3 level of cervical spinal cord, subsequent encounter
S14.103S	Unspecified injury at C3 level of cervical spinal cord, sequela
S14.104A	Unspecified injury at C4 level of cervical spinal cord, initial encounter
S14.104D	Unspecified injury at C4 level of cervical spinal cord, subsequent encounter
S14.104S	Unspecified injury at C4 level of cervical spinal cord, sequela
S14.105A	Unspecified injury at C5 level of cervical spinal cord, initial encounter
S14.105D	Unspecified injury at C5 level of cervical spinal cord, subsequent encounter
S14.105S	Unspecified injury at C5 level of cervical spinal cord, sequela
S14.106A	Unspecified injury at C6 level of cervical spinal cord, initial encounter
S14.106D	Unspecified injury at C6 level of cervical spinal cord, subsequent encounter
S14.106S	Unspecified injury at C6 level of cervical spinal cord, sequela
S14.107A	Unspecified injury at C7 level of cervical spinal cord, initial encounter
S14.107D	Unspecified injury at C7 level of cervical spinal cord, subsequent encounter
S14.107S	Unspecified injury at C7 level of cervical spinal cord, sequela
S14.108A	Unspecified injury at C8 level of cervical spinal cord, initial encounter
S14.108D	Unspecified injury at C8 level of cervical spinal cord, subsequent encounter
S14.108S	Unspecified injury at C8 level of cervical spinal cord, sequela
S14.109A	Unspecified injury at unspecified level of cervical spinal cord, initial encounter
S14.109D	Unspecified injury at unspecified level of cervical spinal cord, subsequent encounter
S14.109S	Unspecified injury at unspecified level of cervical spinal cord, sequela
S24.101A	Unspecified injury at T1 level of thoracic spinal cord, initial encounter
S24.101D	Unspecified injury at T1 level of thoracic spinal cord, subsequent encounter
S24.101S	Unspecified injury at T1 level of thoracic spinal cord, sequela
S24.102A	Unspecified injury at T2-T6 level of thoracic spinal cord, initial encounter
S24.102D	Unspecified injury at T2-T6 level of thoracic spinal cord, subsequent encounter
S24.102S	Unspecified injury at T2-T6 level of thoracic spinal cord, sequela
S24.103A	Unspecified injury at T7-T10 level of thoracic spinal cord, initial encounter
S24.103D	Unspecified injury at T7-T10 level of thoracic spinal cord, subsequent encounter
S24.103S	Unspecified injury at T7-T10 level of thoracic spinal cord, sequela
S24.104A	Unspecified injury at T11-T12 level of thoracic spinal cord, initial encounter
S24.104D	Unspecified injury at T11-T12 level of thoracic spinal cord, subsequent encounter
S24.104S	Unspecified injury at T11-T12 level of thoracic spinal cord, sequela
S24.109A	Unspecified injury at unspecified level of thoracic spinal cord, initial encounter
S24.109D	Unspecified injury at unspecified level of thoracic spinal cord, subsequent encounter
S24.109S	Unspecified injury at unspecified level of thoracic spinal cord, sequela
S24.131A	Anterior cord syndrome at T1 level of thoracic spinal cord, initial encounter
S24.131D	Anterior cord syndrome at T1 level of thoracic spinal cord, subsequent encounter
S24.131S	Anterior cord syndrome at T1 level of thoracic spinal cord, sequela
S24.132A	Anterior cord syndrome at T2-T6 level of thoracic spinal cord, initial encounter
S24.132D	Anterior cord syndrome at T2-T6 level of thoracic spinal cord, subsequent encounter
S24.132S	Anterior cord syndrome at T2-T6 level of thoracic spinal cord, sequela
S24.133A	Anterior cord syndrome at T7-T10 level of thoracic spinal cord, initial encounter
S24.133D	Anterior cord syndrome at T7-T10 level of thoracic spinal cord, subsequent encounter
S24.133S	Anterior cord syndrome at T7-T10 level of thoracic spinal cord, sequela
S24.134A	Anterior cord syndrome at T11-T12 level of thoracic spinal cord, initial encounter
S24.134D	Anterior cord syndrome at T11-T12 level of thoracic spinal cord, subsequent encounter
S24.134S	Anterior cord syndrome at T11-T12 level of thoracic spinal cord, sequela
S24.139A	Anterior cord syndrome at unspecified level of thoracic spinal cord, initial encounter
S24.139D	Anterior cord syndrome at unspecified level of thoracic spinal cord, subsequent encounter
S24.139S	Anterior cord syndrome at unspecified level of thoracic spinal cord, sequela
S24.151A	Other incomplete lesion at T1 level of thoracic spinal cord, initial encounter
S24.151D	Other incomplete lesion at T1 level of thoracic spinal cord, subsequent encounter
S24.151S	Other incomplete lesion at T1 level of thoracic spinal cord, sequela
S24.152A	Other incomplete lesion at T2-T6 level of thoracic spinal cord, initial encounter
S24.152D	Other incomplete lesion at T2-T6 level of thoracic spinal cord, subsequent encounter
S24.152S	Other incomplete lesion at T2-T6 level of thoracic spinal cord, sequela
S24.153A	Other incomplete lesion at T7-T10 level of thoracic spinal cord, initial encounter
S24.153D	Other incomplete lesion at T7-T10 level of thoracic spinal cord, subsequent encounter
S24.153S	Other incomplete lesion at T7-T10 level of thoracic spinal cord, sequela
S24.154A	Other incomplete lesion at T11-T12 level of thoracic spinal cord, initial encounter
S24.154D	Other incomplete lesion at T11-T12 level of thoracic spinal cord, subsequent encounter
S24.154S	Other incomplete lesion at T11-T12 level of thoracic spinal cord, sequela
S24.159A	Other incomplete lesion at unspecified level of thoracic spinal cord, initial encounter
S24.159D	Other incomplete lesion at unspecified level of thoracic spinal cord, subsequent encounter
S24.159S	Other incomplete lesion at unspecified level of thoracic spinal cord, sequela
S34.101A	Unspecified injury to L1 level of lumbar spinal cord, initial encounter
S34.101D	Unspecified injury to L1 level of lumbar spinal cord, subsequent encounter
S34.101S	Unspecified injury to L1 level of lumbar spinal cord, sequela
S34.102A	Unspecified injury to L2 level of lumbar spinal cord, initial encounter
S34.102D	Unspecified injury to L2 level of lumbar spinal cord, subsequent encounter
S34.102S	Unspecified injury to L2 level of lumbar spinal cord, sequela
S34.103A	Unspecified injury to L3 level of lumbar spinal cord, initial encounter
S34.103D	Unspecified injury to L3 level of lumbar spinal cord, subsequent encounter
S34.103S	Unspecified injury to L3 level of lumbar spinal cord, sequela
S34.104A	Unspecified injury to L4 level of lumbar spinal cord, initial encounter
S34.104D	Unspecified injury to L4 level of lumbar spinal cord, subsequent encounter
S34.104S	Unspecified injury to L4 level of lumbar spinal cord, sequela
S34.105A	Unspecified injury to L5 level of lumbar spinal cord, initial encounter
S34.105D	Unspecified injury to L5 level of lumbar spinal cord, subsequent encounter
S34.105S	Unspecified injury to L5 level of lumbar spinal cord, sequela
S34.109A	Unspecified injury to unspecified level of lumbar spinal cord, initial encounter
S34.109D	Unspecified injury to unspecified level of lumbar spinal cord, subsequent encounter
S34.109S	Unspecified injury to unspecified level of lumbar spinal cord, sequela
S34.139A	Unspecified injury to sacral spinal cord, initial encounter
S34.139D	Unspecified injury to sacral spinal cord, subsequent encounter
S34.139S	Unspecified injury to sacral spinal cord, sequela

ICD-10-CM Codes that DO NOT Support Medical Necessity

Expand All | Collapse All

Group 1

(1 Code)

Group 1 Paragraph

All those not listed under the “ICD-10-CM Codes that Support Medical Necessity” section of this article.

Group 1 Codes

Code	Description
XX000	Not Applicable

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code	Description
999x	Not Applicable

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code	Description
99999	Not Applicable

Other Coding Information

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format

Code	Descriptor Generic Name	Descriptor Brand Name	Exclusion Effective Date	Exclusion End Date	Reason for Exclusion
			N/A	N/A

Non-Excluded CPT/HCPCS Ended Codes - Table Format

Code	Descriptor Generic Name	Descriptor Brand Name	Exclusion Effective Date	Exclusion End Date	Reason for Exclusion

Revision History Information

Revision History Date	Revision History Number	Revision History Explanation
03/08/2024	R3	Article revised and published on 07/25/2024 effective for dates of service on and after 03/08/2024. The following ICD-10-CM codes have been added to Group 1 Codes: D32.0, D32.1, I65.01, I65.02, I65.03, I65.21, I65.22, I65.23, I67.1, M47.15, M47.22, M47.812, and M47.816. This revision is in response to an inquiry. Minor formatting changes have been made throughout the article.
10/01/2023	R2	Article revised and published on 10/26/2023 effective for dates of service on and after 10/01/2023 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM code has been added to the article: R40.2A in Code Group 1.
10/01/2020	R1	Revision Number: 1 Publication: September 2020 Connection LCR B2020-013 Explanation of Revision: Based on review for Annual ICD-10-CM Code Updates, ICD-10-CM codes G11.11 and G11.19 have been added to the billing and coding article Group 1. ICD-10-CM code G11.1 has been deleted and therefore has been removed from the billing and coding article Group 1. Additional formatting changes have been made throughout the document. The effective date of this revision is for dates of service on or after October 1, 2020.

Associated Documents

Related Local Coverage Documents
LCDs
L33958 - Somatosensory Testing

Updated On	Effective Dates	Status
07/19/2024	03/08/2024 - N/A	Currently in Effect	You are here
10/20/2023	10/01/2023 - 03/07/2024	Superseded	View
09/25/2020	10/01/2020 - 09/30/2023	Superseded	View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

N/A

Read the Article Disclaimer

License Agreements
American Medical Association Current Procedural Terminology
American Dental Association Current Dental Terminology
American Hospital Association NUBC UB-04

Please review the licensing information below and indicate your agreement and acceptance.

License for Use of Current Procedural Terminology (CPT)

End User Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the American Medical Association (AMA).

You, your employees, and agents are authorized to use CPT only as agreed upon with the AMA internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza, 330 Wabash Ave., Suite 39300, Chicago, IL 60611-5885. Applications are available at the AMA Web site, http://www.ama-assn.org/go/cpt http://www.ama-assn.org/go/cpt.

Applicable FARS\DFARS Restrictions Apply to Government Use.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, AMA Plaza, 330 N. Wabash Ave., Suite 39300, Chicago, IL 60611-5885. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of FAR 52.227-14 (December 2007) and/or subject to the restricted rights provisions of FAR 52.227-14 (December 2007) and FAR 52.227-19 (December 2007), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT should be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS disclaims responsibility for any liability attributable to end user use of the CPT. CMS will not be liable for any claims attributable to any errors, omissions, or other inaccuracies in the information or material contained on this page. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

License For Use of Current Dental Terminology (CDT^TM)

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. By clicking below on the button labeled "I accept", you hereby acknowledge that you have read, understood, and agreed to all terms and conditions set forth in this agreement.

If you do not agree with all terms and conditions set forth herein, click below on the button labeled "I do not accept" and exit from this computer screen.

If you are acting on behalf of an organization, you represent that you are authorized to act on behalf of such organization and that your acceptance of the terms of this agreement creates a legally enforceable obligation of the organization. As used herein, "you" and "your" refer to you and any organization on behalf of which you are acting.

Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association web site, http://www.ADA.org/ http://www.ADA.org/.

Applicable Federal Acquisition Regulation Clauses (FARS)/Department of Defense Federal Acquisition Regulation supplement (DFARS) Restrictions Apply to Government Use.

Organizations who contract with CMS acknowledge that they may have a commercial CDT license with the ADA, and that use of CDT codes as permitted herein for the administration of CMS programs does not extend to any other programs or services the organization may administer and royalties dues for the use of the CDT codes are governed by their commercial license.

ADA DISCLAIMER OF WARRANTIES AND LIABILITIES

CDT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values, or related listings are included in CDT. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for software, including any CDT and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third-party beneficiary to this Agreement.

CMS DISCLAIMER

The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. End Users do not act for or on behalf of the CMS. CMS disclaims responsibility for any liability attributable to end user use of the CDT. CMS will not be liable for any claims attributable to any errors, omissions, or other inaccuracies in the information or material covered by this license. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I Accept". If you do not agree to the terms and conditions, you may not access or use software. Instead, you must click below on the button labeled "I Do Not Accept" and exit from this computer screen.

License For Use of National Uniform Billing Committee (NUBC) UB-04

These materials contain NUBC Official UB-04 Specifications (UB-04 Data), which is copyrighted by the American Hospital Association (AHA).

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "I ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "I DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN. IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use UB-04 Data only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of UB-04 Data is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this Agreement. You acknowledge that the AHA holds all copyright, trademark, and other rights in UB-04 Data. You shall not remove, alter, or obscure any AHA copyright notices or other proprietary rights notices included in the materials.
Any use not authorized herein is prohibited, including, by way of illustration and not by way of limitation, making copies of UB-04 Data for resale and/or license, transferring copies of UB-04 Data to any party not bound by this agreement, creating any modified or derivative work of UB-04 Data, or making any commercial use of UB-04 Data. License to use UB-04 Data for any use not authorized herein must be obtained through the American Hospital Association, 155 N. Wacker Drive, Suite 400, Chicago, Illinois, 60606. Applications are available at the NUBC website, http://www.nubc.org/ http://www.nubc.org/.
The UB-04 Data included in this product is commercial technical data and/or computer databases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Hospital Association, 155 N. Wacker Drive, Suite 400, Chicago, Illinois 60606. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (December 2007) and FAR 52.227-19 (December 2007), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.
AHA DISCLAIMER OF WARRANTIES AND LIABILITIES. UB-04 Data is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. The sole responsibility for the software, including any UB-04 Data and other content contained therein, is with the Medicare/Medicaid Contractor or the CMS; and no endorsement by the AHA is intended or implied. The AHA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The AHA is a third-party beneficiary to this Agreement.
CMS DISCLAIMER. The scope of this license is determined by the AHA, the copyright holder. Any questions pertaining to the license or use of the UB-04 Data should be addressed to the AHA. End users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE UB-04 DATA. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

Submit Feedback/Ask a Question

Billing and Coding: Somatosensory Testing

Document Note

Note History

Contractor Information

Article Information

General Information

CMS National Coverage Policy

Article Guidance

Response To Comments

Coding Information

Bill Type Codes

Revenue Codes

CPT/HCPCS Codes

Group 1

CPT/HCPCS Modifiers

Group 1

ICD-10-CM Codes that Support Medical Necessity

Group 1

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

ICD-10-PCS Codes

Group 1

Additional ICD-10 Information

Bill Type Codes

Revenue Codes

Other Coding Information

Group 1

Coding Table Information

Revision History Information

Associated Documents

Keywords

Page Help for Article - Billing and Coding: Somatosensory Testing (A57540)

Introduction

Finding a specific code

More information

Printing a Document to PDF

Get email updates

CMS & HHS WEBSITES

HELPFUL LINKS

RSS FEEDS